Agreement to Participate in Research

Before beginning survey, please read and indicate your agreement to participate in this research by clicking the box below:

TITLE OF RESEARCH PROJECT: Anxiety in Young Adoptees
I have been asked to participate in a survey-based research study that is investigating anxiety and young adoptees. The results of this study should further our understanding of anxiety symptoms in adoptees ages 2.5 to 12 years .
I understand that:
1. I will be asked to take a survey online that should take approximately five to ten minutes.
2. The possible psychological risks may be some discomfort based on reaction to the survey questions. Should any feelings be elicited based on my participation in this study, I may contact San Mateo County Behavioral Health and Services at (800) 686-0101 No physiological risks are anticipated.
3. There are no discernible benefits to me personally, although the results of this study will help expand our knowledge of anxiety in young adoptees.
4. Although alternative procedures may be used, the present procedure is the most advantageous and economical.
5. The results of this study may be published, but any information from this study that can be identified with me will remain confidential and the data will be pooled to maintain anonymity.
6. Any questions about my participation in this study will be answered by Kera Burdick at Any questions or concerns about this study should be addressed to Dr. Nusha Askari at Complaints or concerns about this study may be addressed to Dr. Kim Tolley, (Chair, Institutional Review Board, NDNU) at (650) 508-3464.
7. My consent is given voluntarily without being coerced. I may refuse to participate in this study or in any part of this study, and I may withdraw at any time, without prejudice to my relation with NDNU Clinical Psychology and Gerontology Dept. or with any future contact with NDNU.
8. Clicking the button below indicates that I have made a decision whether or not to participate. By clicking on the box, I verify that I have read the information, have agreed to participate, and that I am at least 18 years or older to participate.
9. This form may be printed at the end of the survey.

1. Please indicate agreement to participate by clicking "yes" in box below.